Colleen Heyel, Nick Singletary, Maya Davis, Ragan Trotter
What is PTSD?
PTSD, official name: Post Traumatic Stress Disorder, is an anxiety disorder, which is developed after exposure to a terrifying event or ordeal in which physical harm occurred, seen or was threatened.
These traumatic events are usually triggered by violent personal assaults, natural or human-caused disasters, accidents, or military combat.
People with PTSD have persistent frightening thoughts and memories of their traumatic situation and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled.
Symptoms
PTSD symptoms can be grouped into three categories:
Re-experiencing symptoms
Avoidance symptoms
Hyperarousal symptoms
1. Re-experiencing symptoms:
Flashbacks
Bad dreams
Frightening thoughts.
Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms:
Staying away from places, events, or objects that are reminders of the experience
Feeling emotionally numb
Feeling strong guilt, depression, or worry
Losing interest in activities that were enjoyable in the past
Having trouble remembering the dangerous event.
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine.
3. Hyperarousal symptoms:
Being easily startled
Feeling tense or “on edge”
Having difficulty sleeping, and/or having angry outbursts.
Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Soldier who has suffered from PTSD
Causes of PTSD
rape
kidnapping
murder
witness to a natural disaster or other horrifying event
being involved in war (PTSD has been highly prevelant in vietnam war veterans)
violence
PTSD Currently in Afghanistan: 1. Many people in Afghanistan are suffering from PTSD. There are not enough doctors with experience to treat this large group of people.
2. 1 out of every 5 Iraq, Afghanistan vets have some form of PTSD.
3. About 75% of Afghan women suffering from PTSD.
4. The torture that the Afghans received was due to the loss of freedom which was taken by the Taliban.
“more than any previous war, the wars in Iraq and Afghanistan are likely to produce a high percentage of troops suffering from PTSD,” due to the widespread use of improvised explosive devises, multiple rotations, the ambiguity of fighting combatants dressed as civilians, and the use of National Guard members and Reservists."
"In their lawsuit, Veterans for Common Sense and Veterans United for Truth, which represent about 12,000 veterans combined, claim Iraq and Afghanistan war vets are dying while waiting for the VA to treat PTSD and work through a backlog of at least half-a-million disability claims. The groups want Conti to issue a preliminary injunction to force the VA to immediately treat veterans who show signs of PTSD and are at risk of suicide." (VA= veterans affairs)
PTSD Clinical Research
The Trauma is Over But Pain Remains Learn More About a PTSD Study.
What’s important to note when you talk about the Afghans is, these are a people who are suffering en masse from PTSD. The Afghans have suffered through three decades of violence, and unfortunately I don’t think that that violence is going to end anytime soon.
I am sure Mr. Exum knows what he’s talking about in terms of military strategy and no doubt he has good advice to give our nation’s leaders. And indeed, the Afghan people have suffered. As a gross indicator of suffering, there are currently 2.8 million Afghan refugees; one in four refugees in the world is an Afghan, making Afghans by far the largest group of refugees (anyone know what the second largest group is?). But I take issue (and you should too) with his psychiatric acumen.
People are suffering; but not everyone has posttraumatic stress disorder (PTSD). Best estimates of the prevalence of PTSD in Afghanistan are in the 30-50% range (see Lopes Cardozo et al, 2004, in the Journal of the American Medical Association), although to be honest even these suffer from a lack of access to national samples. “En masse” is not a third-to-a-half.
Moreover, it’d be hard to argue that there’s much that is “post” about PTSD diagnoses in Afghanistan. With continuing fighting on the ground, it’s probably more appropriate to diagnose (if we must) PTSD symptoms as acute stress reactions, some of which may develop to full-blown PTSD.
However, most disturbing is not Exum’s misstatements about PTSD prevalence rates, but rather the statement that follows it. The connection between violent behavior is tenuous at best, although it certainly has gotten a lot of play in the press (the New York Times ran a piece last year on violence among returning Iraq War vets that essentially blamed PTSD for murder rates among these men and women). Let me say here unequivocally: PTSD does not make someone violent. Some people with PTSD are violent, but the limited research on this seems to indicate that that it is not because of their PTSD. To state that war will not end in Afghanistan immediately following a statement that everyone there has PTSD is therefore most unfortunate. PTSD is not a barrier to peace, anymore than other injuries caused by war.
A theme I’ve touched on before is the misuse of psychological diagnoses to indicate suffering. This has a long and storied history as regards PTSD, and it irks to no end those of us who actually work with patients who actually have PTSD. People with PTSD are suffering in a maladaptive way. Suffering on its own is terrible enough, but it’s not maladaptive; let’s not degrade the terms for maladaptive suffering by misusing them.
written by: Andrew Exum
Preventing PTSD
1. Go to the source
2. Education
3. Debriefing on the stress of the critical incident
4. Treatment
5. Patient Education
6. Pharmacotherapy (Drug Therapy)
7. Psychotherapy
- The sooner, the better!
Examples of PTSD in Kamal
“Kamal [sat] in the basement just a few feet away from me. But when he and his father came over to our side of the room and I saw Kamal’s face. He had withered-there was simply no other word for it. His eyes gave me a hollow look and no recognition at all registered in them. His shoulders hunched and his cheeks sagged like they were too tired to cling to the bone beneath” (124).
Then Kamals father told Baba about Kamal saying he was, “Should have never let him go alone…always so handsome…four of them took him…bleeding down there…his pants…doesn’t talk anymore…just stares…” (124).
“Kamal’s lifeless body lay on his fathers lap. His right hand, uncurled and limp, bounced to the rhythm of his father’s sobs” (124).
Kaml’s father was telling Baba how, “three months before, a stray bullet had struck his wife in the temple and killed her” (120). This could have caused Kamal’s father to kill himself when, “Kamal’s father was standing with Karim’s gun in his hand. But before any of us could say or do anything. Kamal’s father shoved the barrel in his own mouth” (124).
Examples of PTSD in Sohrab
When Fahrid was leaving the hotel room, he paused in the doorway saying, “Good bye, Sohrab jan. He waited for a reply, but Sohrab paid him no attention. Just rocked back and forth, his face lit by the silver glow of the images flickering across the screen” (312). Sohrab was showing signs of PTSD by showing that he is not able to connect to other people or express any sentimental emotions.
When Amir and Sohrab reminisce in front of the mosque, Sohrab sees a, “horse drawn cart clip-clopped by in the parking lot. Little bells dangled from the horse’s neck and jingled with each step”. This reminds Sohrab of being sexually abused by the Taliban when he, “starts crying, softly, silently”. This also leads Sohrab to ask, “Will God put me in hell for what I did to that man” (318)? Sohrab expresses that he blames himself for what the Taliban which is another sign of PTSD.
Sohrab shows more signs of self-blame when he asks, “Do you think Father is disappointed in me?” The thought of Sohrab parents and friends not seeing him right now makes him cry when he, “wipes his face with the sleeve of his shirt. It burst a bubble of spittle that had formed on his lips. He buries his face in his hands and wept a long time”. He goes on to blame himself by saying, “But sometimes I’m glad they’re not here anymore. Because I don’t want them to see me…I’m so dirty and full of sin (319).
Sohrab also has trouble trusting other people by saying, “What if you get tired of me? What if your wife doesn’t like me? I don’t want to go to another orphanage, he said. He tears were soaking the pillow (327).
Once Amir breaks his promise with Sohrab to go back to the orphanage, instantly Sohrab is in a state of panic. The memories seem like flash backs for Sohrab’s because he starts pleading, “Please promise you wont! Oh God, Amir agha! Please promise you wont! Wept into my shirt until his tears dried, until his shaking stopped and his frantic pleas dwindled to indecipherable mumbles”. The memories are so bad that Sohrab falls asleep crying. Amir then remembered that, “that’s how children deal with terror. They fell asleep (342).
Sohrab’s fear of going back to the orphanage gave him reason to commit suicide by cutting himself with Amir’s razor. This left him, “pale with a large purple bruise in the crease of his right arm” (354).
When Sohrab is on 24 hour suicide watch in the hospital, Amir tries to cheer him up and tell him that he is not going to the orphanage. However, Sohrab is seen having problems trusting others such as Amir because Sohrab only, “holds [a] glance, and then looked away” when Amir is trying to cheer him up. Sohrab has a, “face is set like stone. His eyes were still lightless, vacant, the way I had found them when I had pulled him out of the bathtub” (354). Sohrab allowed the lack of trust from others as a reason to give up on life.
Sohrab also expresses signs of PTSD by telling Amir that he is, “tired of everything”. Sohrab then brings his hand to his throat, “I want my old life back, I want Father and Mother Jan. I want Sasa. I wanted to play with Rahim Khan Sahib in the garden. I want to live in our house again” (354). Sohrab also expresses the symptom of remorse for wanting to go back into the past.
Sohrab’s PTSD becomes so bad that Amir wonders if Sohrab, “seen the Taliban drag his parents out into the street (317).
After Sohrab comes to America Sohrab becomes silent all the time. Amir sees this as an affect from all the abuse Sohrab undergone by the Taliban when he says, “It was the silence of one who has taken cover in a dark place, curled up all the edges and tucked them under (361). Amir sees Sohrab’s unwillingness to communicate with others again when he says, “Sohrab walked like he was afraid to leave behind footprints. He moved as if not to stir the air around him. Mostly, he slept (365).
Other Children Affected by the War on Terror
Other children are affected on a different degree because they don’t show many signs of PTSD. However, they still need someone to provide them their psychological and security needs. When Amir goes to Fahrids brother house, he comes across some children who were, “all thin with dirtcaked faces” (238). Amir thought one of the younger boys wanted his watch; however, he realized that the kids only wanted his food when he says, “They hadn’t been staring at my watch at all. They have been staring at my food” (241).
Other Children such as Wahid’s sons were starving for some food. Wahid’s wife, Maryam, tells Amir that, “Only the Taliban can afford meat now” (238). The significance of her telling this displays how people in Afghanistan do not have much food to eat because the Taliban have made society provide food and goods for their own desires.Amir then made sure that the boys would not go hungry by, “[planting] a fistful of crumpled money under a mattress” (242).
When Amir and Fahrid go to the new orphanage they meet the orphanage director named Zaman. During their conversation, Fahrid starts attacking Zaman because he sold Sohrab to the Taliban. Amir notices that the children are watching and crying when he says, “They were standing silently by the door, holding hands and some of them were crying” (256). The children in the orphanage show symptoms of PTSD by being stunned to any violence around them.
Amir as an example of America
Amir is supposed to represent America in the Kite Runner. Although, America reason for going into Afghanistan was to find Osama Bin Laden, they must make sure that they like Afghanistan more stable before pulling out. Amir exemplifies America because he addresses this need to help others become physically, emotionally, and physiologically secure. America knows if they are making any changes or can still have hope in a better future for Afghanistan is by looking at any significant changes regardless of how small they might be.
When Amir was trying to search for Sohrab at the new orphanage he notices, “a little girl with her left leg amputated below the knee”. Then Amir remembers Wahid’s sons and realizes that he must not leave Afghanistan without finding Sohrab (255). Amir realizes that Sohrab needs someone who he can provide him safety, security, and shelter
After Amir realizes that he needs to save Sohrab, he knows his assignment is to make sure Sohrab is cheerful just like his father Hassan. When Sohrab starts blaming himself for the things that happen to him, Amir tries to cheer him up by saying, “You’re not dirty, and you’re not full of sin”. Amir then, “reaches gently and pulls Hassan to [him],” and says, “I won’t hurt you, I whispered. I promise. He resisted a little, He let me draw him to me and rested his head on my chest. Would you like to come live in America with me and my wife (320)? Sohrab resting his head on Amir, gives Amir hope to keep helping him.
Amir has reason to hope again helping after he, “crosses a strip of warm, black tarmac and brought Hassan’s son from Afghanistan to America, lifting him from the certainty of turmoil and dropping him in turmoil of uncertainty (356).
At the end of the, Kite Runner, Amir finally gets Sohrab to smile which gives Amir hope to keep helping Sohrab. Amir looked down at Sohrab and saw, “one corner of his mouth had curled up just so. A smile. Lopsided. Hardly there. But there. I blinked and the smile was gone. But it had been there. I had seen it. It was only a smile, nothing more. It didn’t make everything all right. It didn’t make anything all right. Only a smile. A tiny thing. But I’ll take it. With open arms”. Amir finally realizes that he is helping Sohrab become more emotionally, physically, and psychologically stably when he says, “When spring comes, it melts the snow one flake at a time, and maybe I just witnessed the first flake melting” (371).
PTSD
Post Traumatic Stress Disorder
Colleen Heyel, Nick Singletary, Maya Davis, Ragan TrotterWhat is PTSD?
Symptoms
PTSD symptoms can be grouped into three categories:
1. Re-experiencing symptoms:
Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.
2. Avoidance symptoms:
Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine.
3. Hyperarousal symptoms:
Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Causes of PTSDPTSD Currently in Afghanistan:
1. Many people in Afghanistan are suffering from PTSD. There are not enough doctors with experience to treat this large group of people.
2. 1 out of every 5 Iraq, Afghanistan vets have some form of PTSD.
3. About 75% of Afghan women suffering from PTSD.
4. The torture that the Afghans received was due to the loss of freedom which was taken by the Taliban.
“more than any previous war, the wars in Iraq and Afghanistan are likely to produce a high percentage of troops suffering from PTSD,” due to the widespread use of improvised explosive devises, multiple rotations, the ambiguity of fighting combatants dressed as civilians, and the use of National Guard members and Reservists."
"In their lawsuit, Veterans for Common Sense and Veterans United for Truth, which represent about 12,000 veterans combined, claim Iraq and Afghanistan war vets are dying while waiting for the VA to treat PTSD and work through a backlog of at least half-a-million disability claims. The groups want Conti to issue a preliminary injunction to force the VA to immediately treat veterans who show signs of PTSD and are at risk of suicide." (VA= veterans affairs)
PTSD Clinical Research
The Trauma is Over But Pain Remains Learn More About a PTSD Study.
What’s important to note when you talk about the Afghans is, these are a people who are suffering en masse from PTSD. The Afghans have suffered through three decades of violence, and unfortunately I don’t think that that violence is going to end anytime soon.
I am sure Mr. Exum knows what he’s talking about in terms of military strategy and no doubt he has good advice to give our nation’s leaders. And indeed, the Afghan people have suffered. As a gross indicator of suffering, there are currently 2.8 million Afghan refugees; one in four refugees in the world is an Afghan, making Afghans by far the largest group of refugees (anyone know what the second largest group is?). But I take issue (and you should too) with his psychiatric acumen.
People are suffering; but not everyone has posttraumatic stress disorder (PTSD). Best estimates of the prevalence of PTSD in Afghanistan are in the 30-50% range (see Lopes Cardozo et al, 2004, in the Journal of the American Medical Association), although to be honest even these suffer from a lack of access to national samples. “En masse” is not a third-to-a-half.
Moreover, it’d be hard to argue that there’s much that is “post” about PTSD diagnoses in Afghanistan. With continuing fighting on the ground, it’s probably more appropriate to diagnose (if we must) PTSD symptoms as acute stress reactions, some of which may develop to full-blown PTSD.
However, most disturbing is not Exum’s misstatements about PTSD prevalence rates, but rather the statement that follows it. The connection between violent behavior is tenuous at best, although it certainly has gotten a lot of play in the press (the New York Times ran a piece last year on violence among returning Iraq War vets that essentially blamed PTSD for murder rates among these men and women). Let me say here unequivocally: PTSD does not make someone violent. Some people with PTSD are violent, but the limited research on this seems to indicate that that it is not because of their PTSD. To state that war will not end in Afghanistan immediately following a statement that everyone there has PTSD is therefore most unfortunate. PTSD is not a barrier to peace, anymore than other injuries caused by war.
A theme I’ve touched on before is the misuse of psychological diagnoses to indicate suffering. This has a long and storied history as regards PTSD, and it irks to no end those of us who actually work with patients who actually have PTSD. People with PTSD are suffering in a maladaptive way. Suffering on its own is terrible enough, but it’s not maladaptive; let’s not degrade the terms for maladaptive suffering by misusing them.
written by: Andrew Exum
Preventing PTSD
1. Go to the source2. Education
3. Debriefing on the stress of the critical incident
4. Treatment
5. Patient Education
6. Pharmacotherapy (Drug Therapy)
7. Psychotherapy
- The sooner, the better!
Examples of PTSD in Kamal“Kamal [sat] in the basement just a few feet away from me. But when he and his father came over to our side of the room and I saw Kamal’s face. He had withered-there was simply no other word for it. His eyes gave me a hollow look and no recognition at all registered in them. His shoulders hunched and his cheeks sagged like they were too tired to cling to the bone beneath” (124).
Then Kamals father told Baba about Kamal saying he was, “Should have never let him go alone…always so handsome…four of them took him…bleeding down there…his pants…doesn’t talk anymore…just stares…” (124).
“Kamal’s lifeless body lay on his fathers lap. His right hand, uncurled and limp, bounced to the rhythm of his father’s sobs” (124).
Kaml’s father was telling Baba how, “three months before, a stray bullet had struck his wife in the temple and killed her” (120). This could have caused Kamal’s father to kill himself when, “Kamal’s father was standing with Karim’s gun in his hand. But before any of us could say or do anything. Kamal’s father shoved the barrel in his own mouth” (124).
Examples of PTSD in Sohrab
When Fahrid was leaving the hotel room, he paused in the doorway saying, “Good bye, Sohrab jan. He waited for a reply, but Sohrab paid him no attention. Just rocked back and forth, his face lit by the silver glow of the images flickering across the screen” (312). Sohrab was showing signs of PTSD by showing that he is not able to connect to other people or express any sentimental emotions.
When Amir and Sohrab reminisce in front of the mosque, Sohrab sees a, “horse drawn cart clip-clopped by in the parking lot. Little bells dangled from the horse’s neck and jingled with each step”. This reminds Sohrab of being sexually abused by the Taliban when he, “starts crying, softly, silently”. This also leads Sohrab to ask, “Will God put me in hell for what I did to that man” (318)? Sohrab expresses that he blames himself for what the Taliban which is another sign of PTSD.
Sohrab shows more signs of self-blame when he asks, “Do you think Father is disappointed in me?” The thought of Sohrab parents and friends not seeing him right now makes him cry when he, “wipes his face with the sleeve of his shirt. It burst a bubble of spittle that had formed on his lips. He buries his face in his hands and wept a long time”. He goes on to blame himself by saying, “But sometimes I’m glad they’re not here anymore. Because I don’t want them to see me…I’m so dirty and full of sin (319).
Sohrab also has trouble trusting other people by saying, “What if you get tired of me? What if your wife doesn’t like me? I don’t want to go to another orphanage, he said. He tears were soaking the pillow (327).
Once Amir breaks his promise with Sohrab to go back to the orphanage, instantly Sohrab is in a state of panic. The memories seem like flash backs for Sohrab’s because he starts pleading, “Please promise you wont! Oh God, Amir agha! Please promise you wont! Wept into my shirt until his tears dried, until his shaking stopped and his frantic pleas dwindled to indecipherable mumbles”. The memories are so bad that Sohrab falls asleep crying. Amir then remembered that, “that’s how children deal with terror. They fell asleep (342).
Sohrab’s fear of going back to the orphanage gave him reason to commit suicide by cutting himself with Amir’s razor. This left him, “pale with a large purple bruise in the crease of his right arm” (354).
When Sohrab is on 24 hour suicide watch in the hospital, Amir tries to cheer him up and tell him that he is not going to the orphanage. However, Sohrab is seen having problems trusting others such as Amir because Sohrab only, “holds [a] glance, and then looked away” when Amir is trying to cheer him up. Sohrab has a, “face is set like stone. His eyes were still lightless, vacant, the way I had found them when I had pulled him out of the bathtub” (354). Sohrab allowed the lack of trust from others as a reason to give up on life.
Sohrab also expresses signs of PTSD by telling Amir that he is, “tired of everything”. Sohrab then brings his hand to his throat, “I want my old life back, I want Father and Mother Jan. I want Sasa. I wanted to play with Rahim Khan Sahib in the garden. I want to live in our house again” (354). Sohrab also expresses the symptom of remorse for wanting to go back into the past.
Sohrab’s PTSD becomes so bad that Amir wonders if Sohrab, “seen the Taliban drag his parents out into the street (317).
After Sohrab comes to America Sohrab becomes silent all the time. Amir sees this as an affect from all the abuse Sohrab undergone by the Taliban when he says, “It was the silence of one who has taken cover in a dark place, curled up all the edges and tucked them under (361). Amir sees Sohrab’s unwillingness to communicate with others again when he says, “Sohrab walked like he was afraid to leave behind footprints. He moved as if not to stir the air around him. Mostly, he slept (365).
Other Children Affected by the War on Terror
Other children are affected on a different degree because they don’t show many signs of PTSD. However, they still need someone to provide them their psychological and security needs. When Amir goes to Fahrids brother house, he comes across some children who were, “all thin with dirtcaked faces” (238). Amir thought one of the younger boys wanted his watch; however, he realized that the kids only wanted his food when he says, “They hadn’t been staring at my watch at all. They have been staring at my food” (241).
Other Children such as Wahid’s sons were starving for some food. Wahid’s wife, Maryam, tells Amir that, “Only the Taliban can afford meat now” (238). The significance of her telling this displays how people in Afghanistan do not have much food to eat because the Taliban have made society provide food and goods for their own desires.Amir then made sure that the boys would not go hungry by, “[planting] a fistful of crumpled money under a mattress” (242).
When Amir and Fahrid go to the new orphanage they meet the orphanage director named Zaman. During their conversation, Fahrid starts attacking Zaman because he sold Sohrab to the Taliban. Amir notices that the children are watching and crying when he says, “They were standing silently by the door, holding hands and some of them were crying” (256). The children in the orphanage show symptoms of PTSD by being stunned to any violence around them.
Amir as an example of America
Amir is supposed to represent America in the Kite Runner. Although, America reason for going into Afghanistan was to find Osama Bin Laden, they must make sure that they like Afghanistan more stable before pulling out. Amir exemplifies America because he addresses this need to help others become physically, emotionally, and physiologically secure. America knows if they are making any changes or can still have hope in a better future for Afghanistan is by looking at any significant changes regardless of how small they might be.
When Amir was trying to search for Sohrab at the new orphanage he notices, “a little girl with her left leg amputated below the knee”. Then Amir remembers Wahid’s sons and realizes that he must not leave Afghanistan without finding Sohrab (255). Amir realizes that Sohrab needs someone who he can provide him safety, security, and shelter
After Amir realizes that he needs to save Sohrab, he knows his assignment is to make sure Sohrab is cheerful just like his father Hassan. When Sohrab starts blaming himself for the things that happen to him, Amir tries to cheer him up by saying, “You’re not dirty, and you’re not full of sin”. Amir then, “reaches gently and pulls Hassan to [him],” and says, “I won’t hurt you, I whispered. I promise. He resisted a little, He let me draw him to me and rested his head on my chest. Would you like to come live in America with me and my wife (320)? Sohrab resting his head on Amir, gives Amir hope to keep helping him.
Amir has reason to hope again helping after he, “crosses a strip of warm, black tarmac and brought Hassan’s son from Afghanistan to America, lifting him from the certainty of turmoil and dropping him in turmoil of uncertainty (356).
At the end of the, Kite Runner, Amir finally gets Sohrab to smile which gives Amir hope to keep helping Sohrab. Amir looked down at Sohrab and saw, “one corner of his mouth had curled up just so. A smile. Lopsided. Hardly there. But there. I blinked and the smile was gone. But it had been there. I had seen it. It was only a smile, nothing more. It didn’t make everything all right. It didn’t make anything all right. Only a smile. A tiny thing. But I’ll take it. With open arms”. Amir finally realizes that he is helping Sohrab become more emotionally, physically, and psychologically stably when he says, “When spring comes, it melts the snow one flake at a time, and maybe I just witnessed the first flake melting” (371).
Citations:
(February 24, 2010). National Institute of Health. Retrieved from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
http://eldib.wordpress.com/2009/01/29/iraq-afghanistan-us-veterans-patients-exceed-400000/
http://www.torontosun.com/news/columnists/peter_worthington/2009/05/01/9310996-sun.html